A BMJ Case Reports article describes a middle-aged, otherwise healthy man in the UK who presented with acute left-sided numbness and ataxia and was found to have an extreme blood pressure of 254/150 mm Hg. Neuroimaging demonstrated cerebral arterial vasospasm and a thalamic infarct, consistent with a hypertensive stroke. Extensive evaluation revealed no conventional secondary causes. He did not smoke, drink alcohol, or use recreational drugs, and metabolic, autoimmune, cardiac, renal, hepatic, and vascular investigations were unremarkable.
The patient was initially hospitalized and treated for an acute stroke and severe hypertension. Two antihypertensive agents were started, and after three days, his blood pressure improved but remained markedly elevated at 170/80 mm Hg. He was discharged with instructions for close home monitoring and scheduled follow-up. Despite ongoing care, blood…
